Dear Dr. M,
It's not like I hadn't heard of you before we walked into your office that day. Your reputation as the best developmental pediatrician around is why we stood in front of you. I had done the research on you, both professional and personal. I knew who I was looking at but I still stared a little too long during our greeting in the hospital lobby. I wanted to really understand the woman who held so much power over our world. The hospital lobby was drab and dated. It crossed my mind that the hospital was desperately overdue for a makeover. I escaped my current situation and imagined the steel and glass it would take to update the entire structure. I became abnormally interested in the architecture of the hospital as you and Alex exchanged pleasantries. I was safe as long as I stood and stared at the "modern" design of an architect who peaked in the '80s. I didn't want to move toward the elevator as I would then be committed to this assessment but when Alex readily stepped in behind you we were on the move. I stepped carefully along the yellow line that led patients to the X-ray departments? Specimen Collection? Wherever. It was broken in spots from years of people dragging their feet along it. When we reached the elevator I lingered on this line a little too long. You and Alex moved swiftly into the waiting elevator. Kate happy to be in Alex's arms clutching her Buzz Lightyear. I reluctantly stepped off the line and into the elevator.
You were smiling at Kate. She smiled back. The elevators had mirrors inside so I was able to surreptitiously watch you interact with Kate. I took in your makeup-less face. Good, I thought. She is such a scholar that she has no time for trivial things like cosmetics. Surely, an intellect like her would not falsely diagnose our Kate. This would all be straightened out in a matter of hours.
You led us down the hall towards your exam room. We walked past sick children. We walked by mothers and fathers so damaged by their child's illness that they appeared hollow. I willed myself to prioritize our current scenario. I shamed myself when I could not. You'll be surprised to know how many thoughts violated my mind during that short walk.
When we entered the room Kate happily greeted the lady that waited inside. A speech pathologist as I remember. She didn't interest me near as much as you. I knew she would be aiding you in your observations on that day but she appears faintly in my memory while you stand out vibrant and alive as if it were yesterday. The room was large and bare. A small table and three chairs sat haphazardly in one corner as if they were moved hastily out of the way. The floor was carpeted in an industrial maroon that bore the signs of years of traffic in and out of that door. How many people were crushed inside that room? How many times did a parent stare at the barren threads of this offensively antiquated carpet to avoid crying in front of you? How many succeeded?
Kate chose you that day. Kate chose you to be her person in that room. I had originally considered that act of social interaction to be a wonderful reason for you to determine that she was far too social for autism to be a consideration. Oh, how wrong I was. I would soon obsessively research autism and its many characteristics to the point where I could detect it in someone I saw walking down the street. Not this day though. This day, those myths that I work so hard to dispel now were giving me false hopes and I liked it.
You asked questions of my husband and me. None of them surprised me. I had rehearsed my answers a million times in the weeks leading up to the appointment.
Does Kate make regular eye contact?
Of course. She is very friendly. (She never could hold it for long but that wasn't the question you asked, was it?)
Was Kate up on her toes, at all?
Not that I had ever noticed. I looked to my husband for support. I knew he was less than obsessively attentive to these kinds of things. He was an engineer. I worked with children with autism all day long. I knew what that could mean. He concurred. I exhaled.
You smiled sweetly. Not in pity or exasperation for my obvious denial, but in a kind gesture of empathy for the battle you knew was overwhelming my brain.
Does she show interest in her peers?
She would but she is new to her daycare. She doesn't know of them yet. She is not yet two. Do 2 year olds pay attention to peers? I tried desperately to imagine our eldest daughter Grace at age two. The image crushed me without warning as Grace was highly verbal and was speaking in full sentences by now. I quickly pushed that image away. How unfair that something that, once made me so proud, could break my heart at that moment.
The questions and observations went on for hours. You made notes. Your speech pathologist friend made notes. I watched your pen move looking for the tell-tale movements of writing a capital letter A. You were careless with your notes. You scribbled them out quickly. This suited my profile of you but it offended me in a small way, too. I wanted every word you wrote about Kate to be meticulous. I wanted some control.
When you were finished with your observation you left us in the room sitting on the floor with Kate. I played half-heartedly trying to show Alex that I was convinced this was all a big misunderstanding. He did the same. You were gone only minutes. This I knew was not a good sign.
You entered the room and motioned for us sit in the chair opposite you. Kate sat on my lap. Kindly, the very first sentence out of your mouth was this:
Kate has Autism Spectrum Disorder.
I had not prepared sufficiently to hear this. Who could, I guess? I heard that sentence and then I heard nothing else. I signed some papers. Your eyes were so kind. I'm sure you would have walked me to the car if Alex had not been there. You talked for a while. I stared at your kind eyes, some more. My husband answered you. Was the speech pathologist still there? I can't remember. My heart hurt. Not my feelings. The heart in my chest ached. It rejected your words. My brain was nodding along with you. I was dizzy. I held in my tears.
It was my mother's birthday, you know. We were heading to her birthday party directly after the appointment. Just a small party. Family only. It was a 30 minute drive. We didn't speak. Alex held my hand. Kate played happily in the back.
Upon arriving at my mother's house for her party we piled out of the car. I walked in first. I was anxious to get it over with. I walked in with my eyes down. When I raised my head my brother was looking at me with those same kind eyes. Then the tears came.
It's been many months since that day. I've stopped crying for the most part. I tend to cry only in my car now. It is the only place I am ever alone. I don't cry because Kate has autism anymore. I cry because I hate to see her struggle.
I wanted to thank you for your kindness that day and I really wanted you to know that Alex and I have since found relief in this diagnosis. I have stopped obsessing over milestones. I am no longer consumed with dangerously unprofessional Internet checklists about autism. We are getting to know Kate so much better now that you have started us on the path to learn how to communicate with her.
So, thank you, Dr. M. Thank you for understanding that Kate wasn't the only one who struggled to make eye contact on that day. Thank you for intuitively reaching out with small gestures of kindness because something as personal as a hug would have had me wracked with sobs. Most of all, thank you, for promising to follow Kate as long as we need you because we surely need you now.
Best,
Kate's mom.
